The Unreported Threat in Coverage of Anthrax: Journalists Fail to Focus on the Longer-Term Dangers of Antibiotic Resistance. (Coverage of Terrorism)

Caper, Philip, Nieman Reports

During the impressive print and electronic media coverage of recent events concerning the threat of bioterrorism through anthrax dissemination, one major threat has been almost completely ignored by the press. It is that posed by the widespread and indiscriminate use of antibiotics to "treat" perceived but perhaps not real exposure to anthrax spores. This is a major omission and has potentially disastrous consequences.

Humans, together with almost every other biological creature, live side by side with or actually act as hosts to other organisms, including large numbers of bacteria. Under normal conditions, bacteria live on our skin, in our nasal passages, and in our intestines. Examples of such organisms include strains of E. coli (intestines), staphylococcus and streptococcus (skin, respiratory and oral passages), and various fungi (skin and respiratory passages).

All animals, including humans, have developed pretty effective ways of maintaining defenses against uncontrolled proliferation of these bacteria. Occasionally, we are infected by organisms that we encounter routinely in our daily environments--meaning that we have encountered an unusual strain to which we have no immunity or our immune systems are compromised, as in the case of HIV. When normally harmless microorganisms--those a normal immune system can keep in check--gain the upper hand and are able to multiply within our bodies to an abnormal extent, we are said to be infected by them.

During the past 75 years or so, we have developed various chemical and biologic agents that are more toxic to microorganisms than they are to humans and are therefore useful in supplementing our natural defenses against microorganisms. Examples of these include so-called chemotherapeutic agents (such as sulfonamides) and antibiotics, such as penicillin and tetracyclines. Ciprofloxin (Cipro) now considered to be the "treatment of choice" (but not the only treatment) of anthrax is an antibiotic. These agents are extremely valuable in restoring the delicate equilibrium we maintain with other biological creatures with which we (usually) peacefully coexist when they have gained the upper hand for one of the reasons mentioned earlier.

But their use is not without risks. And their indiscriminate and inappropriate use is positively dangerous, yet this very real danger has not adequately been brought to the public's attention as part of the reporting on anthrax.

Our bodies are normally inhabited by hundreds of millions of individual bacteria of dozens of strains. Like humans, these individual bacteria differ from one another in a variety of ways. One of the differences most important to us is in their degree of sensitivity to antibiotics. Some individual bacteria are rather easily killed by these drugs, and others are more resistant to them. When antibiotics are taken, the most susceptible bacteria are killed first and the least susceptible last. Sometimes the bacteria most resistant to antibiotics are not killed at all, leaving them free to multiply after the course of drugs is discontinued.

When this happen, we have used our own bodies as a medium for breeding an antibiotic-resistant strain of the very bacteria we are trying to control. In doing so, we have created a situation that is worse than if we had not attempted antibiotic treatment at all, since the competition for food and other resources provided by the antibiotic sensitive bacteria that had held the growth of the resistant strains in check has been removed. When the antibiotics are discontinued, the resistant strains of bacteria are able to grow without restraint, and the infection returns--but this time in a pure antibiotic resistant form.

The use of antibiotics without specific indications, in inadequate dosage or for an insufficient period of time, is much worse than not using them at all. The recent emergence of drug-resistant strains of tuberculosis and staphylococcus are examples of the result of inappropriate and indiscriminate antibiotic use--in humans and animals. …

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